Provider Demographics
NPI:1710540091
Name:ANDREWS, CARLY THERESE (BSN, RN, PHN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:THERESE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4392
Mailing Address - Country:US
Mailing Address - Phone:206-765-6159
Mailing Address - Fax:
Practice Address - Street 1:389 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3977
Practice Address - Country:US
Practice Address - Phone:206-765-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95175551163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health